Health sector keeping close eye on nurse inquiry

THE CANADIAN PRESS

ST. THOMAS, Ont. — A nurse who killed elderly patients in her care was disciplined several times over poor job performance but no one thought she was seriously harming people at the long-term care home where she worked, a former supervisor testified Monday at the public inquiry examining Elizabeth Wettlaufer's actions.

Wettlaufer has confessed to murdering eight patients and attempting to kill several more by injecting them with overdoses of insulin at long-term care homes and private residences in Ontario for nearly a decade.

Seven of the patients Wettlaufer killed were residents of Caressant Care in Woodstock, Ont., and the inquiry heard the now 51-year-old nurse had committed her first murder not long after starting her job at the facility in June 2007.

"We now know that within weeks of being hired by Caressant Care she assaulted two residents by injecting them with insulin and within six weeks of being hired she had actually killed her first person,'' said Paul Scott, lawyer for the family of deceased victim Helen Matheson.

But for years administrators at the facility saw Wettlaufer only as an underperforming employee making relatively minor errors, said Helen Crombez, the former director of nursing at the home.

"Beth had some very good sides that we saw, that's why (the murder confession) was such a shock,'' Crombez said. ``She was making some mistakes but doing other things fairly well.''

In 2008, Wettlaufer failed to administer insulin to a pair of patients who needed it, the inquiry heard Monday. Crombez said it was only in the days leading up to the public inquiry that she realized Wettlaufer may have been hoarding the insulin to use for some other purpose.

Wettlaufer's other disciplinary issues included failing to properly document when a new patient was admitted to the home, failing to properly administer eye drops and generally neglecting her duties, resulting in her colleagues having to do more work, Crombez said.

By August 2012, Caressant administrators had ``some concern'' for patient safety as a result of Wettlaufer's job performance and told her they would ask the College of Nurses to review her fitness to practice nursing if she did not improve, Crombez testified. But, the former supervisor noted, there was no belief Wettlaufer had caused ``sustained harm.''

"We wanted her to understand that she needed to perform properly,'' Crombez said. "It was just letting her know (that) if things continued, this could be a consideration.''

Wettlaufer, who on many nights was the only registered nurse on duty at Caressant Care, had told her employers that she was caring for her father, who had Alzheimer's disease, and that a recent change in her medication for mental health issues had her feeling unlike herself, Crombez said.

The nurse was ultimately fired from Caressant Care in 2014 for making multiple errors when giving medication to patients, the inquiry heard.

Wettlaufer's crimes went undetected until she confessed them to mental health workers and police in 2016. She went on to plead guilty to eight counts of first-degree murder, four counts of attempted murder and two counts of aggravated assault, and was sentenced last summer to life in prison without parole eligibility for 25 years.

In an interview with AdvocateDaily.com, Toronto health lawyer Mary Jane Dykeman says those who work in the health sector are watching the inquiry very closely and awaiting the report that will come out of it next year.

“Similar to a coroner’s inquest, the inquiry will create systemic recommendations to make every effort to prevent this from happening in the future,” she says. “Anyone with standing at the inquiry will advocate and ultimately, a decision will be made about the list of recommendations.”

Dykeman, a partner with DDO Health Law, notes that there’s a great deal of emphasis on the question of how a nurse who had been subject to so many complaints was able to walk away with a reasonable letter of reference and gain jobs in other health-care settings. It raises many concerns about the system and its checks and balances, she says.

“We want to get practical, implementable recommendations that improve the system,” she says. "Eight vulnerable people lost their lives and that is shocking and likely terrifying for the public. People want to place their family members in a facility that is as much like their own home as possible.”

Dykeman says the inquiry may result in legislative, systemic and regulatory changes for the College of Nurses of Ontario and the Ministry of Health and Long-Term Care, given the latter’s compliance oversight in long-term care.

As a result of this tragedy, she is concerned that the public will become worried there are no “good” long-term care homes.

“There are issues that need to be addressed and this obviously should never have happened,” Dykeman says. “But it’s also important for people to know that dedicated staff are working in long-term-care homes throughout Ontario around the clock, diligently providing care to the most vulnerable group in society.

“The rogue actions of one nurse shouldn’t take away from that — but I recognize that it’s bound to.”

With Canada’s aging population, recommendations to improve the long-term care system serving a growing number of seniors is critical, Dykeman says.

“The aging population, including those with Alzheimer’s and dementia, is only set to balloon over the next 10 to 20 years,” she says. “We do have systemic issues to attend to so that we’re in a position to provide great care as we need it.”